title: Bulimia nervosa and its relation to voice changes in young adults: A simple review of epidemiology, complications, diagnostic criteria and management.
abstract: BACKGROUND
  Bulimia nervosa (BN) is a type of feeding disorder that starts in adolescence and presents a variety of symptoms, recurrent vomiting in the oral cavity that may reach down to the larynx - similarly to gastro-esophageal reflux, causing laryngeal and voice disorder alterations.
  
  
  OBJECTIVE
  These studies aimed at surveying the literature and investigate the studies that considered BN a risk factor for voice disorders and its epidemiology, complications, diagnostic criteria, and management.
  
  
  METHODS
  A review of the literature was done based on a survey of BIOMED CENTRAL and COCHRANE @ OVID databases, which are linked to the IMU ezproxy virtual library (http://ezp.imu.edu.my/menu). The keywords "bulimia nervosa", "teenage complications" and "voice changes" were used. Citations with summaries were chosen to limit the topic, for the period between 2000 and 2010, in English.
  
  
  RESULTS
  Of the ninety three papers we found, twenty three were used as a basis for this review. Among them, only three discuss BN as an etiology factor associated with voice changes in adult women, and we did not find any paper associating this with bulimic teenagers.
  
  
  CONCLUSIONS
  It is necessary to observe laryngeal and vocal signs and symptoms associated with BN, especially in teenagers whose voices are going through a period of change. The contribution of this type of investigation, which should begin with a clinical history, is essential for minimizing the complications of bulimia nervosa. Thus, adolescents and adults with voice disorders should be investigated in greater detail.
authors.affiliation: Department of Pharmacy Practice, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia.
authors.forename: Kingston
authors.initials: K
authors.lastname: Rajiah
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Mathew
authors.forename: Sajesh K
authors.initials: SK
authors.lastname: Veettil
authors.forename: Suresh
authors.initials: S
authors.lastname: Kumar
keywords: Bulimia nervosa; teenage complications; voice changes